Thursday, July 25, 2013

Living with Kirby

In the previous post, Mom had been discharged from the hospital on Friday, July 5, after yet another abdominal surgery to take care of an infection at the site where her peritoneal dialysis catheter had been inserted (June of 2012) and later removed (October of 2012). The surgeon left the wound open this time so a wound vacuum could be used to promote healing and prevent infection. Now Mom is facing two to three weeks of being attached to a small pump by a length of plastic tubing coming out of the dressing over this surgery site, which is to the right of and slightly higher than her belly button. The pump is in a black nylon carrying case with a matching black shoulder strap, so at least she can be somewhat stylish while she's out and about.When I was at her house the day after she got out of the hospital, I referred to the pump as "Kirby" at one point (hence the title of this post). I was thinking about Kirby vacuums when I said that (we had one the whole time I was growing up), but the Nintendo video game character named Kirby is also a decent match, since that Kirby is small and cute just like the pump, and one of the main things he does is inhale objects (although a bit more dramatically than the pump does.) So use whichever reference works best for you.The first visit from the home health care nurse to change Mom's dressing and check on Kirby was the morning of Monday, July 8. It did hurt some when the old dressing was being removed, but I suppose that is to be expected since there must be some sort of adhesive used in order to create a good seal between the outermost dressing and Mom's skin. And I suppose removing gauze that has been in an open wound for two or three days might not feel good either. But at least Mom did get some good news from the nurse. On the mornings the nurse comes to change the dressing, Mom can disconnect the hose from the pump and take a shower before the nurse arrives. (Mom was not too excited about possibly going at least two weeks without a real shower.)Mom's nephrologist, Dr. N, happened to come to the dialysis clinic on Monday while she was there. He said it looks like she has lost some weight and he ended up lowering her dry weight. (A dialysis patient's "dry weight," which I initially talked about in the February 9, 2013 post, is what the patient would weigh without any excess fluid.) I do not know how long it has been since her dry weight was adjusted, but given how much weight she has lost this past year it probably should have been adjusted down several times. I know Mom has had to specifically request they remove more fluid than they were planning to remove on more than one occasion, especially while traveling. Dr. N thinks what happened on the cruise ship was they did not remove enough fluid during the first two dialysis sessions because they were basing it off of the paperwork Fresenius sent to Dialysis at Sea, which is sent quite a bit in advance of the cruise. So this is another reason why a dialysis patient really needs to be aware of everything that happens during dialysis and be their own advocate.As I mentioned before, Kirby can be unplugged and operate on battery power for up to four hours, so it is not a problem for Mom to take short trips in the car to run errands. But longer car trips would be less practical, because she would either have to charge Kirby soon after reaching her destination, or stop along the way to plug in Kirby for awhile to recharge the battery. I knew Mom was going to a memorial service on Thursday for her aunt who recently passed away at the age of 97, and that was about a 90 minute drive from her house. Fortunately I remembered I have a device for the car that converts the power from the car's 12 VDC power socket to 120 VAC. It happens to be shaped like a coffee mug so it fits in a cup holder. I put my electrical engineering degree to good use and confirmed that Kirby's power supply does not require more power than the power converter is designed to supply. Then on Tuesday she made a test run with Kirby plugged into it when Cathy took her to the airport to pick up her cousin who was also coming in for the Thursday memorial service. Everything worked just fine, so on Thursday she used it on the way to and from the memorial service, which meant she did not have to keep looking for a place to plug Kirby in while they were down there.

On Friday, July 12, the home health care nurse said Mom's wound is healing very well, so she may be done with Kirby sooner than was initially estimated. Some more good news came on Friday regarding dialysis. They have started trying to do the buttonhole technique for the access on Mom's arm. (See the February 9. 2013 post for a description of the buttonhole technique.) Hopefully that will go well and significantly reduce the pain when the needles are inserted.During the next week, Kirby and the power converter were put to use on short notice, and this trip probably would not have happened without the power converter for the car. Mom's travel buddy Ed (most prominently mentioned in the post describing their 2011 trip to Russia) was in a hospital in Houston and not doing well at all, and due to Mom's surgeries and travels she had not been able to see him since before his surgery in June. At the urging of my sister Laura we moved or cancelled a few appointments and created a window of opportunity such that my wife Cathy could drive Mom to Houston after dialysis on Wednesday, July 17, then drive back on Thursday. That's about a four hour drive to Houston, but she was able to keep Kirby plugged in during the entire drive there and back. Unfortunately Ed did pass away late Thursday afternoon while Cathy and Mom were driving back home. He lived life to the fullest up until the very end, choosing to continue traveling extensively despite the wishes of his doctors and his family. He will be missed.But before Mom and Cathy went to Houston on Wednesday, the home health care nurse came by to change Mom's dressing. Mom told her she had been feeling a small knot below the wound, beneath the skin, and it was a little tender. The nurse checked it and said it does feel like there is something there that may need to be drained. Mom was understandably upset over that bit of news. Laura called Dr. K's office to get an appointment, but the earliest they could see her was the following Wednesday, one week away. So Mom will keep a close eye on it, and if it starts oozing or if she starts running a fever, we won't wait to take her to an emergency room.I went over to Mom's house Friday morning to take a look at her malfunctioning garage door opener, and when she greeted me at the door I did not see Kirby. I asked her where Kirby was and she said when the nurse changed the dressing this morning she said Mom did not need the wound vacuum any more, and she just put a normal dressing back on. So that was a nice birthday present for Mom, especially considering she was in the hospital with a kidney infection on her birthday in 2011, then last year she was diagnosed with bronchitis on her birthday.So Kirby the wound vacuum was a part of Mom's life for two weeks, from July 5 to July 19. Let's hope this time the wound continues to heal without getting infected.